Renal tumors

Benign prostatic hyperplasia

Question: what is the etiology of renal tumors?

1. Hormonal violation/dysfunction
2. Exposure to ionizing radiations
3. Chemical matters (benzene , dibenzanthracen, benzpyrene,
methylcholantren, aflatoxin B)
4. Viral infections
5. Cigarette smoking

Question: what is the classification of renal tumors?

A. According to pathology
1. Malignant
i. Renal cell carcinoma (RCC): accounting for 90% of all malignant renal
tumors
RCC are further classified as;
 Clear - cell: 60 - 85%
 Chromophilic: 7 - 14%
 Chromophobic: 4 - 10%
 Oncocytic: 2 - 5%
 Collecting duct: 1 - 2%.
Palpating a megascopic kidney, increase and
ii. Wilms' tumour (Nephroblastoma)asymmetry of stomach
iii. Renal cell adenocarcinoma
iv. Transitional and squamous cell carcinomas
v. Sarcomas (Leiomyosarcomas)
2. benign
i. renal cysts (70% cases of all benign tumors)
ii. adenoma,
iii. fibroma,
 iv. renal oncocytoma,
v. renal angiomyolipoma,
vi. lipoma,
vii. myoma
viii. lymphangioma,
ix. Hemangioma
3. inflammatory tumors
B. TNM classification
Tx – primary tumor cannot be assessed;
To- no evidence of primary tumour;
Tl - tumour < 7 cm in greatest dimension limited to the kidney;
T1a - tumour 4 cm or less;
T1b- tumour more than 4 cm but not more than 7 cm
T2 - tumour > 7 cm in greatest dimension limited to the kidney; Palpating, displaced
T3 - tumour extends into major veins or involve adrenal or perinephric
tissues but not beyond Gerota's fascia; T3-Palpating, displaced limitedly. Bilateral
orhiectomia, endocrine and radial and
endocrine
T3a - tumour invades adrenal gland or perinephric tissues but not beyond
Gerota's fascia;
T3b - tumour grossly extends into renal vein or vena cava;
T3c - tumour grossly extends into vena cava above the diaphragm; T4 -
tumour invades beyond Gerota's fascia T4- palpating, not displaced
NO - no regional lymph node metastasis;
C. N1 - metastasis to a single regional lymph node;
D. N2 - metastasis in more than one regional lymph node;
E. MO - no distant metastases;
F. Ml - distant metastasis.

Question: name the symptoms and clinical findings of kidney's tumors

1. Clinical symptoms of RCC: haematuria, palpable tumour and flank pain

2. Asymptomatic
3. general weakness/rapid fatigue
4. decrease or loss of appetite Symptoms of adenocarcrinoma
Immobile kidney, varicocele, edemata of feet,
5. loss of weight
asymmetry of stomach
6. Increase body temperature (sometimes about 38-39 С),
7. chill
8. anemia.

Clinical findings

1. Total haematuria (60-88 % cases of tumors)

2. Sometimes after haematuria there is the typical attack of kidney colic that
is halted together with out development of blood clots (4-10 sm).
3. Haematurain exists at 1-2 urination or a few hours or days, and then it is
suddenly disappear. The next bleeding can appear in a few days, months
and even years.
4. Distant metastases, at the time of diagnosis, are found in 30% of patients.
5. Symptoms owing to metastatic disease:
i. Raised ESR
ii. weight loss
iii. cachexia
iv. fever
v. night sweats, and the sudden development of a varicocele
6. Hypertension is due to segmental artery occlusion or to elaboration of
renin or renin-like substances.

Question: what are the diagnostic methods or renal tumors?

1. CBC: high ESR, low Hemoglobin

2. Urinalysis: gross or microscopic hematuria, leukocyturia, proteinuria
3. Biochemical blood test: high creatinine level, presence of paraproteins, high
alkaline phosphate
4. Cystoscopy: blood discharge from ureters may be revealed,
 5. Abdominal ultrasound: allows to distinguish solid mass from the cyst
6. CT scan: Standard radiological procedure is an abdominal CT-scan with or
without contrast medium. It can show the extend of metastasis
7. Plain abdominal X-ray: shows enlargement of whole or part of the kidney;
changing of kidney shape, abnormal position of the organ; presence of
calcifications.
8. Excretory Urography – IVP:
Enlargement of poles of kidneys, distorted renal configuration, the
architecture of the collecting system varies from simple deformity of a calyx
to outright destruction of one or more calyces with their amputation.
9. Renal arteriography; aortography; phlebography an inferior vena
cavography : may reveal narrow vessels, tumor masses
10. MRI: provides detailed features of the kidneys; highly sensitive in
demonstrating hemorrhage, hemorrhagic cyst and thrombi.

Question: what is the treatment of renal cell carcinoma?

Treatment depends on the stage or degree of tumor dissemination.
Treatment options are;
A. Surgical therapy (effective treatment for localized renal cell carcinoma T1
&T2)
i. radical nephrectomy - removal of the entire tumorous kidney
including fatty capsule and adrenal gland within Gerota's fascia
followed by lymph node dissection
B. non-surgical therapy
1. transfemoral catheter embolization of inoperable and symptomatic tumors
 2. Radiation therapy: high-energy beams aimed the cancer to destroy the
cancer cells. Radiation therapy usually comes from a machine that moves
around the body, directing the energy beams to precise points.
3. chemotherapy (5- fluoro-2-deoxyuridine, vinblastine (VB), lomustine)
4. hormonal therapy (progesterone, testosterone,
5. immunotherapy (good for metastatic disease)
i. interferon (IFN),
ii. interleukin (IL)-2
iii. BCG,
iv. transfer factor (TF),
6. Combinations of above (when tumor has spread already).

Question: name the different types of urinary bladder tumors?

1. transitional cell carcinoma (most common)
2. squamous carcinoma
3. Adenocarcinoma

Question: what is the Staging of the urinary bladder tumours?

Stage I. Cancer at this stage occurs in the bladder's inner lining but hasn't
invaded the muscular bladder wall.
Stage II. At this stage, cancer has invaded the bladder wall but is still
confined to the bladder.
Stage III. The cancer cells have spread through the bladder wall to
surrounding tissue. They may also have spread to the prostate in men or
the uterus or vagina in women.
Stage IV. By this stage, cancer cells may have spread to the lymph nodes and
other organs, such as your lungs, bones or liver.
 Ta - papillary, epithelial confined tumour,
Tis - flat, in situ carcinoma,
Tl - tumour invades lamina propria of urothelium
T2 - tumour invades superficial muscle layer (inner half),
T3a - tumour invades profound muscle layer (outer half),
T3b - tumour invades perivesical fat,
T4 - tumour invades pelvic viscera like rectum, pelvic walls, prostatic stroma
or uterus.
NO - there are no metastases in regional lymph nodes,
N1- there is single positive node less than or equal to 2 cm in diameter,
N2 - there is single positive lymph node greater than 2 cm but less than 5
cm in diameter, or multiple positive nodes less than 5 cm in diameter,
N3 - positive lymph nodes greater than 5 cm in diameter.
M0- metastasis of tumor absent
M1-metastasis to neighboring organs present
Question: What are the clinical symptoms of tumor of the bladder?
1. May be asymptomatic until disease is advanced
2. hematuria (microscopic or gross)
3. dysuria Basic symptoms- intermittent painless of
macrohaematuria with blood clots
4. urgency and frequent urinations
5. Back pain
6. Pelvic pain
Question: name the complication of bladder tumors
1. Hemorrhage
2. Anemia
3. Pneumonia
4. Urine retention or incontinence

Question: what is the diagnostic procedure of urinary bladder tumors?

1. Excretory and retrograde urograms; reveals filling defects
 2. Ultrasound
3. Cystoscopy and cystography

4. Biopsy
5. CT scan
Question: What is the medical tactics in the patients with tumor of the bladder?
1. Biological therapy (immunotherapy)
i. An immune-stimulating bacterium (Bacille Calmette-Guerin (BCG))
ii. interferon (IFN),
iii. interleukin (IL)-2
iv. transfer factor (TF),
2. chemotherapy (5- fluoro-2-deoxyuridine, vinblastine (VB), lomustine)
3. hormonal therapy (progesterone, testosterone)
4. Radiation therapy: high-energy beams aimed the cancer to destroy the
cancer cells. Radiation therapy usually comes from a machine that moves
around the body, directing the energy beams to precise points.
Surgical method of bladder tumor treatment (for early stages of cancer/tumor)
1. Transurethral resection (TUR) is often used to remove bladder cancers that
are confined to the inner layers of the bladder

2. partial cystectomy, the removal of the tumor and only the portion of the
bladder that contains cancer cells
3. Radical cystectomy is an operation to remove the entire bladder, as well as
surrounding lymph nodes. In men, radical cystectomy typically includes
removal of the prostate and seminal vesicles. In women, radical cystectomy
involves removal of the uterus, ovaries and part of the vagina.

Question: what is benign prostatic hyperplasia-BPH?

It is a noncancerous enlargement of the prostate gland

Question: what are the symptoms of BPH?

• Stream of urine weaker

• Flow only starts after a period of waiting - hesitancy
• Need to go to the toilet more frequently or urgently
• Having to get up several times during the night
• Urine flow stops and starts
• Dribbling at the end of urine flow
• Occasional incontinence
The symptoms are quantified using the International Prostate Symptom Score
Symptom scores.

0-7 mildly symptomatic

8- 19 moderately symptomatic
 Elastic feel
20 - 35 severely symptomatic
Question: what are the physical findings in BPH?
1. Distended suprapubic area due to urine retention
2. Digital rectal examination reveals enlarged prostrate

Question: what is the diagnostic procedure of BPH?

1. Digital rectal examination: reveals clearness of contours of gland, increase
in size
2. Blood test: Elevated prostate specific antigen (PSA) levels, high creatinine
level in case of renal failure Ultrasonography must be done
to confirm this diagnosis
3. Urinalysis: presence of blood, leukocytes, bacteria, protein.
4. Cystoscopy: intravesical signs are; ‘’fishing’s hooks”
5. Ultrasound of prostate gland: increase size of prostate
6. X-ray signs: Spherical, even, symmetric defect of urinary bladder is in the
area of neck,
7. Excretory urograms, MRI

Question: what is the treatment of BPH?

Pharmacologic (medical) treatment:
1. Alpha-1–receptor blockers (prazosin and terazosin): used to 'relax' the
smooth muscle of the prostate.
2. Phosphodiesterase-5 enzyme inhibitors
3. 5-alpha reductase inhibitors (Finasteride)
4. Anticholinergic agents (Atropine, Benzatropine (Cogentin), Biperiden,
Ipratropium (Atrovent))
 Surgery
1. Transurethral resection of the prostate (TURP)
2. Open prostatectomy - Reserved for patients with very large prostates
(>75 g), patients with concomitant bladder stones or bladder diverticula,
and patients who cannot be positioned for transurethral surgery
3. Laser therapy: A laser probe is inserted through the urethra and the
prostate tissue is then treated with the laser.

Question: what is the etiology of prostate cancer?

1. Hereditary
2. Viral infections (retrovirus)
3. Medication exposure (statins
Question: what are the stages of prostate cancer?
The prostate cancer stages are:
Stage I. This stage signifies very early cancer that's confined to a small area
of the prostate. When viewed under a microscope, the cancer cells aren't
considered aggressive.
Stage II. Cancer at this stage may still be small but may be considered
aggressive when cancer cells are viewed under the microscope. Or cancer
that is stage II may be larger and may have grown to involve both sides of
the prostate gland.
Stage III. The cancer has spread beyond the prostate to the seminal vesicles
or other nearby tissues.
Stage IV. The cancer has grown to invade nearby organs, such as the bladder, or
spread to lymph nodes, bones, lungs or other organs.

Question: what are the symptoms of prostate cancer?

1. Asymptomatic until advance stage.
2. frequent urination,
3. nocturia
4. Difficulty starting and maintaining a steady stream of urine,
5. hematuria and
6. dysuria

Question: what are the diagnostic methods of prostate cancer?

1. Urinalysis: hematuria
During palpation- there is a hard consistency with no clear contour
2. Digital rectal examination of prostate
3. Prostate specific antigen (PSA) increases
4. Prostate biopsy: atypical cells, metaplasia and anaplasia
5. Ultrasound of prostate

Question: what is the difference between the diagnosis of BPH and prostate
cancer? Punctate biopsy of prostate
Histological and cytological examination of bioptate (prostate)

Question: what is the treatment of prostate cancer?

1. chemotherapy (5- fluoro-2-deoxyuridine, vinblastine (VB), lomustine)
2. hormonal therapy (progesterone, testosterone,
3. Radical prostatectomy Peridural anaesthesia
0-4 specific antigen

Threatening of complication after prostectomy- bleeding

and tamponade of urinary bladder

Symptoms of BHP
nocturia, dysuria

Two stage- dysuria, pollacuria, feeling of incomplete emptying

of urinary bladder